Question

Which one of the following is NOT a principle followed in the management of missile injuries?

• A. Excision of all dead muscles
• B. Removal of foreign bodies
• C. Removal of fragments of bone
• D. Leaving the wound open

Hint:

Bone fragments are not treated the same way as dead muscle or loose debris — think about which fragments keep their blood supply.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks which of the four listed steps is NOT one of the accepted principles of wound debridement and management in missile (gunshot/blast) injuries.

Step 2: Key Concept or Approach:
Standard missile wound management follows debridement principles aimed at removing dead or contaminated tissue while preserving whatever viable tissue is left. All non-viable muscle is excised, accessible foreign material is removed, and the wound is left open for delayed primary closure a few days later to reduce the risk of gas gangrene and other wound infections. Bone, however, is treated differently from soft tissue — only loose, completely detached bone fragments are removed. Fragments that remain attached to periosteum or surrounding soft tissue retain a blood supply and are deliberately preserved, since removing them causes unnecessary bone loss and defect.

Step 3: Working Through the Options:
Excision of all dead muscle is a correct, standard principle of debridement. Removal of foreign bodies is also standard, since retained debris drives infection. Removal of fragments of bone, stated as a blanket rule, is NOT correct because attached, vascularised bone fragments are preserved rather than removed. Leaving the wound open is correct and central to missile wound management, allowing delayed closure once the wound is clean.

Step 4: Conclusion:
The correct answer is Removal of fragments of bone.